A single individual masked with regard to disease presence examined 107 subjects prospectively recruited from a mixed population of glaucomatous and nonglaucomatous patients for an afferent pupillary defect (RAPD). Researchers sought to assess the RAPD by swinging flashlight as a potentially useful screening test for glaucomatous optic neuropathy.

All subjects underwent a swinging flashlight test with, when necessary, the aid of neutral density filters to determine whether or not a RAPD was present. A determination of glaucoma diagnosis, as well as classification of disease stage, was subsequently assessed based upon review of history and ophthalmic examination. The study researchers ascertained this clinical information regarding glaucomatous disease without knowledge of study RAPD status. The acquisition of such clinical information and performance of swinging flashlight testing for RAPD was conducted by different individuals, the latter being a non-ophthalmologist.

The researchers noted that statistical analysis demonstrated an odds ratio of 9.71 (95% CI, 3.72–25.40) for glaucomatous disease if a RAPD was present, with a sensitivity of 66.7% and a specificity of 82.9%. They also found that subanalysis of patients who had not previously undergone cataract surgery revealed an odds ratio of 17.05 (95% CI, 4.73–61.44) for glaucomatous disease if a RAPD was present, with a sensitivity of 68.8% and a specificity of 88.6%.

RAPD screening by a swinging flashlight test with neutral density filters was moderately sensitive and strongly specific for glaucoma. Sensitivity, specificity and predictive value improved when patients who had previously undergone cataract surgery were removed from the analysis.

To evaluate the effect of intravitreal triamcinolone acetonide (IVTA) on retinal sensitivity in cases of macular edema (ME) secondary to branch retinal vein occlusion (BRVO), the authors of this prospective Turkish study examined 14 eyes of 14 cases of BRVO.

They assessed logMAR visual acuity, central 4° retinal sensitivity by MP-1 microperimetry and optical coherence tomography foveal thickness in each eye at baseline and one, three and six months after IVTA injection.

Ages ranged from 60 to 79 years (mean 68 ± 8 years) and at one, three and six months, the logMAR visual acuity had increased from 0.71 ± 0.21 to 0.42 ± 0.21, 0.46 ± 0.30, and 0.46 ± 0.27; the mean foveal thickness had decreased from 540 ± 88 µm to 254 ± 51 µm, 288 ± 84 µm, and 280 ± 91 µm; and the mean retinal sensitivity had increased from 4.7 ± 2.5 dB to 7.9 ± 2.7 dB, 8.2 ± 3.6 dB and 8.3 ± 4.6 dB, respectively.

To conclude, in eyes with ME secondary to BRVO, IVTA injections result in a significant increase in not only the visual acuity, but also the central 4° retinal sensitivity in six months of follow-up.

The results of three multicenter, randomized, double-masked, placebo-controlled, dose-ranging Phase III studies (SHIEDL, INSURE and ENDURE) were reviewed to determine the efficacy and safety of different doses of secukinumab, a fully human monoclonal antibody for targeted interleukin-17A blockade, in patients with noninfectious uveitis.

A total of 118 patients with Behçet's uveitis (SHIELD study); 31 patients with active, noninfectious, non–Behçet's uveitis (INSURE study); and 125 patients with quiescent, noninfectious, non–Behçet's uveitis (ENDURE study) were enrolled.

After an initial subcutaneous (s.c.) loading phase in each treatment arm, patients received s.c. maintenance therapy with secukinumab 300 mg every two weeks (q2w), secukinumab 300 mg monthly (q4w) or placebo in the SHIELD study; secukinumab 300 mg q2w, secukinumab 300 mg q4w, secukinumab 150 mg q4w or placebo in the INSURE study; or secukinumab 300 mg q2w, secukinumab 300 mg q4w, secukinumab 150 mg q4w or placebo in the ENDURE study. Main outcome measures were a reduction of uveitis recurrence or vitreous haze score during withdrawal of concomitant immunosuppressive medication (ISM). Other endpoints included best-corrected visual acuity, ISM use (expressed as a standardized ISM score) and safety outcomes.

After completion or early termination of each trial, there were no statistically significant differences in uveitis recurrence between the secukinumab treatment groups and placebo groups in any study. Secukinumab was associated with a significant reduction in mean total post-baseline ISM score (p=0.019; 300 mg q4w vs. placebo) in the SHIELD study. Likewise, secukinumab was associated with a greater median reduction in ISM score versus placebo in the INSURE study, although no statistical analysis of the difference was conducted because of the small sample size. It was reported that overall, there was no loss in visual acuity reported in any treatment group during follow-up in all three studies. According to descriptive safety statistics, the frequencies of ocular and nonocular adverse events seemed to be slightly higher among secukinumab groups versus placebo across the three studies.

The primary efficacy endpoints of the three studies were not met. The secondary efficacy data from these studies suggest a beneficial effect of secukinumab in reducing the use of concomitant ISM.